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Sleep is a naturally recurring state of mind and body, characterized by altered consciousness, relatively inhibited sensory activity, inhibition of nearly all voluntary muscles, and reduced interactions with surroundings. It is distinguished from wakefulness by a decreased ability to react to stimuli, but more reactive than coma or disorders of consciousness, sleep displaying very different and active brain patterns. Sleep occurs in repeating periods, in which the body alternates between two distinct modes: REM sleep and non-REM sleep. Although REM stands for "rapid eye movement", this mode of sleep has many other aspects, including virtual paralysis of the body. A well-known feature of sleep is the dream, an experience typically recounted in narrative form, which resembles waking life while in progress, but which usually can later be distinguished as fantasy. During sleep, most of the body's systems are in an anabolic state, helping to restore the immune, nervous, skeletal, and muscular systems; these are vital processes that maintain mood, memory, and cognitive function, and play a large role in the function of the endocrine and immune systems. The internal circadian clock promotes sleep daily at night. The diverse purposes and mechanisms of sleep are the subject of substantial ongoing research. Sleep is a highly conserved behavior across animal evolution. Humans may suffer from various sleep disorders, including dyssomnias such as insomnia, hypersomnia, narcolepsy, and sleep apnea; parasomnias such as sleepwalking and REM behavior disorder; bruxism; and circadian rhythm sleep disorders. The advent of artificial light has substantially altered sleep timing in industrialized countries. Physiology The most pronounced physiological changes in sleep occur in the brain.Pierre A. A. Maquet et al., "Brain Imaging on Passing to Sleep"; Chapter 6 in Parmeggiani & Velluti (2005). The brain uses significantly less energy during sleep than it does when awake, especially during non-REM sleep. In areas with reduced activity, the brain restores its supply of adenosine triphosphate (ATP), the molecule used for short-term storage and transport of energy.Brown, pp. 1118–1119: "Compared with wakefulness, sleep reduces brain energy demands, as suggested by the 44% reduction in the cerebral metabolic rate (CMR) of glucose (791) and a 25% reduction in the CMR of O2 (774) during sleep." In quiet waking, the brain is responsible for 20% of the body's energy use, thus this reduction has a noticeable effect on overall energy consumption. Sleep increases the sensory threshold. In other words, sleeping persons perceive fewer stimuli, but can generally still respond to loud noises and other salient sensory events. During slow-wave sleep, humans secrete bursts of growth hormone. All sleep, even during the day, is associated with secretion of prolactin.Eve Van Cauter & Karine Spiegel (1999). "Circadian and Sleep Control of Hormonal Secretions", in Turek & Zee (eds.), Regulation of Sleep and Circadian Rhythms, pp. 397–425. Key physiological methods for monitoring and measuring changes during sleep include electroencephalography (EEG) of brain waves, electrooculography (EOG) of eye movements, and electromyography (EMG) of skeletal muscle activity. Simultaneous collection of these measurements is called polysomnography, and can be performed in a specialized sleep laboratory.Brown, p. 1087.Rosa Peraita-Adrados, "Electroencephalography, Polysomnography, and Other Sleep Recording Systems"; Chapter 5 in Parmeggiani & Velluti (2005). Sleep researchers also use simplified electrocardiography (EKG) for cardiac activity and actigraphy for motor movements. Non-REM and REM sleep Sleep is divided into two broad types: non-rapid eye movement (non-REM or NREM) sleep and rapid eye movement (REM) sleep. Non-REM and REM sleep are so different that physiologists identify them as distinct behavioral states. Non-REM sleep occurs first and after a transitional period is called slow-wave sleep or deep sleep. During this phase, body temperature and heart rate fall, and the brain uses less energy. REM sleep, also known as paradoxical sleep, represents a smaller portion of total sleep time. It is the main occasion for dreams (or nightmares), and is associated with desynchronized and fast brain waves, eye movements, loss of muscle tone, and suspension of homeostasis.Parmeggiani (2011), Systemic Homeostasis and Poikilostasis in Sleep, pp. 12–15. The sleep cycle of alternate NREM and REM sleep takes an average of 90 minutes, occurring 4–6 times in a good night's sleep. The American Academy of Sleep Medicine (AASM) divides NREM into three stages: N1, N2, and N3, the last of which is also called delta sleep or slow-wave sleep. The whole period normally proceeds in the order: N1 → N2 → N3 → N2 → REM. REM sleep occurs as a person returns to stage 2 or 1 from a deep sleep. There is a greater amount of deep sleep (stage N3) earlier in the night, while the proportion of REM sleep increases in the two cycles just before natural awakening. Awakening ]] Awakening can mean the end of sleep, or simply a moment to survey the environment and readjust body position before falling back asleep. Sleepers typically awaken soon after the end of a REM phase or sometimes in the middle of REM. Internal circadian indicators, along with successful reduction of homeostatic sleep need, typically bring about awakening and the end of the sleep cycle. Awakening involves heightened electrical activation in the brain, beginning with the thalamus and spreading throughout the cortex. During a night's sleep, a small amount of time is usually spent in a waking state. As measured by electroencephalography, young females are awake for 0–1% of the larger sleeping period; young males are awake for 0–2%. In adults, wakefulness increases, especially in later cycles. One study found 3% awake time in the first ninety-minute sleep cycle, 8% in the second, 10% in the third, 12% in the fourth, and 13–14% in the fifth. Most of this awake time occurred shortly after REM sleep. Today, many humans wake up with an alarm clock; however, people can also reliably wake themselves up at a specific time with no need for an alarm. Many sleep quite differently on workdays versus days off, a pattern which can lead to chronic circadian desynchronization. Many people regularly look at television and other screens before going to bed, a factor which may exacerbate disruption of the circadian cycle. Scientific studies on sleep have shown that sleep stage at awakening is an important factor in amplifying sleep inertia. Timing Sleep timing is controlled by the circadian clock (Process C), sleep–wake homeostasis (Process S), and to some extent by individual will. Circadian clock 402px|thumb|The human "[[Circadian rhythm|biological clock"]] Sleep timing depends greatly on hormonal signals from the circadian clock, or Process C, a complex neurochemical system which uses signals from an organism's environment to recreate an internal day–night rhythm. Process C counteracts the homeostatic drive for sleep during the day (in diurnal animals) and augments it at night. The suprachiasmatic nucleus (SCN), a brain area directly above the optic chiasm, is presently considered the most important nexus for this process; however, secondary clock systems have been found throughout the body. An organism whose circadian clock exhibits a regular rhythm corresponding to outside signals is said to be entrained; an entrained rhythm persists even if the outside signals suddenly disappear. If an entrained human is isolated in a bunker with constant light or darkness, he or she will continue to experience rhythmic increases and decreases of body temperature and melatonin, on a period which slightly exceeds 24 hours. Scientists refer to such conditions as free-running of the circadian rhythm. Under natural conditions, light signals regularly adjust this period downward, so that it corresponds better with the exact 24 hours of an Earth day.Phyllis C. Zee & Fred W. Turek (1999), "Introduction to Sleep and Circadian Rhythms", in Turek & Zee (eds.), Regulation of Sleep and Circadian Rhythms, pp. 1–17.Derk-Jan Dijk & Dale M. Edgar (1999), "Circadian and Homeostatic Control of Wakefulness and Sleep", in Turek & Zee (eds.), Regulation of Sleep and Circadian Rhythms, pp. 111–147' The circadian clock exerts constant influence on the body, effecting sinusoidal oscillation of body temperature between roughly 36.2 °C and 37.2 °C.Charles A. Czeisler & Kenneth P. Wright, Jr. (1999), "Influence of Light on Circadian Rhythmicity in Humans", in Turek & Zee (eds.), Regulation of Sleep and Circadian Rhythms, pp. 149–180. The suprachiasmatic nucleus itself shows conspicuous oscillation activity, which intensifies during subjective day (i.e., the part of the rhythm corresponding with daytime, whether accurately or not) and drops to almost nothing during subjective night.Piotr Zlomanczuk & William J. Schwartz (1999). "Cellular and Molecular Mechanisms of Circadian Rhythms in Mammals", in Turek & Zee (eds.), Regulation of Sleep and Circadian Rhythms, pp. 309–342. The circadian pacemaker in the suprachiasmatic nucleus has a direct neural connection to the pineal gland, which releases the hormone melatonin at night. Cortisol levels typically rise throughout the night, peak in the awakening hours, and diminish during the day.Thomas A. Wehr (1999). "The Impact of Changes in Nightlength (Scotoperiod) on Human Sleep", in Turek & Zee (eds.), Regulation of Sleep and Circadian Rhythms, pp. 263–285. Circadian prolactin secretion begins in the late afternoon, especially in women, and is subsequently augmented by sleep-induced secretion, to peak in the middle of the night. Circadian rhythm exerts some influence on the nighttime secretion of growth hormone. The circadian rhythm influences the ideal timing of a restorative sleep episode. Sleepiness increases during the night. REM sleep occurs more during body temperature minimum within the circadian cycle, whereas slow-wave sleep can occur more independently of circadian time. The internal circadian clock is profoundly influenced by changes in light, since these are its main clues about what time it is. Exposure to even small amounts of light during the night can suppress melatonin secretion, and increase body temperature and wakefulness. Short pulses of light, at the right moment in the circadian cycle, can significantly 'reset' the internal clock. Blue light, in particular, exerts the strongest effect, leading to concerns that electronic media use before bed may interfere with sleep. Modern humans often find themselves desynchronized from their internal circadian clock, due to the requirements of work (especially night shifts), long-distance travel, and the influence of universal indoor lighting. Even if they have sleep debt, or feel sleepy, people can have difficulty staying asleep at the peak of their circadian cycle. Conversely they can have difficulty waking up in the trough of the cycle. A healthy young adult entrained to the sun will (during most of the year) fall asleep a few hours after sunset, experience body temperature minimum at 6 a.m., and wake up a few hours after sunrise. Process S Generally speaking, the longer an organism is awake, the more it feels a need to sleep ("sleep debt"). This driver of sleep is referred to as Process S. The balance between sleeping and waking is regulated by a process called homeostasis. Induced or perceived lack of sleep is called sleep deprivation. Process S is driven by the depletion of glycogen and accumulation of adenosine in the forebrain that disinhibits the ventrolateral preoptic nucleus, allowing for inhibition of the ascending reticular activating system. Sleep deprivation tends to cause slower brain waves in the frontal cortex, shortened attention span, higher anxiety, impaired memory, and a grouchy mood. Conversely, a well-rested organism tends to have improved memory and mood.Brown, pp. 1134–1138. Neurophysiological and functional imaging studies have demonstrated that frontal regions of the brain are particularly responsive to homeostatic sleep pressure. There is disagreement on how much sleep debt it is possible to accumulate, and whether sleep debt is accumulated against an individual's average sleep or some other benchmark. It is also unclear whether the prevalence of sleep debt among adults has changed appreciably in the industrialized world in recent decades. Sleep debt does show some evidence of being cumulative. Subjectively, however, humans seem to reach maximum sleepiness after 30 hours of waking. It is likely that in Western societies, children are sleeping less than they previously have. One neurochemical indicator of sleep debt is adenosine, a neurotransmitter that inhibits many of the bodily processes associated with wakefulness. Adenosine levels increase in the cortex and basal forebrain during prolonged wakefulness, and decrease during the sleep-recovery period, potentially acting as a homeostatic regulator of sleep. Coffee and caffeine temporarily block the effect of adenosine, prolong sleep latency, and reduce total sleep time and quality. Social timing Humans are also influenced by aspects of social time, such as the hours when other people are awake, the hours when work is required, the time on the clock, etc. Time zones, standard times used to unify the timing for people in the same area, correspond only approximately to the natural rising and setting of the sun. The approximate nature of the timezone can be shown with China, a country which used to span five time zones and now officially uses only one (UTC+8). Distribution In polyphasic sleep, an organism sleeps several times in a 24-hour cycle, whereas in monophasic sleep occurs all at once. Under experimental conditions, humans tend to alternate more frequently between sleep and wakefulness (i.e., exhibit more polyphasic sleep) if they have nothing better to do. Given a 14-hour period of darkness in experimental conditions, humans tended towards bimodal sleep, with two sleep periods concentrated at the beginning and at the end of the dark time. Bimodal sleep in humans was more common before the industrial revolution. Different characteristic sleep patterns, such as the familiarly so-called "early bird" and "night owl", are called chronotypes. Genetics and sex have some influence on chronotype, but so do habits. Chronotype is also liable to change over the course of a person's lifetime. Seven-year-olds are better disposed to wake up early in the morning than are fifteen-year-olds. Chronotypes far outside the normal range are called circadian rhythm sleep disorders. Naps The siesta habit has recently been associated with a 37% lower coronary mortality, possibly due to reduced cardiovascular stress mediated by daytime sleep. Short naps at mid-day and mild evening exercise were found to be effective for improved sleep, cognitive tasks, and mental health in elderly people. Many people experience a temporary drop in alertness in the early afternoon, commonly known as the "post-lunch dip". While a large meal can make a person feel sleepy, the post-lunch dip is mostly an effect of the circadian clock. People naturally feel most sleepy at two times of the day about 12 hours apart—for example, at 2:00 a.m. and 2:00 p.m. At those two times, the body clock is activated. At about 2 p.m. (14:00), it overrides the homeostatic buildup of sleep debt, allowing several more hours of wakefulness. At about 2 a.m. (02:00), with the daily sleep debt paid off, it is activated again to ensure a few more hours of sleep. Genetics It is hypothesized that a considerable amount of sleep-related behavior, such as when and how long a person needs to sleep, is regulated by genetics. Researchers have discovered some evidence that seems to support this assumption. Monozygotic (identical) but not dizygotic (fraternal) twins tend to have similar sleep habits. Neurotransmitters, molecules whose production can be traced to specific genes, are one genetic influence on sleep which can be analyzed. The circadian clock has its own set of genes.Brown, pp. 1138–1102. Genes which may influence sleep include ABCC9, DEC2, and variants near PAX 8 and VRK2. This content is available under the Creative Commons Attribution License 4.0. Quality The quality of sleep may be evaluated from an objective and a subjective point of view. Objective sleep quality refers to how difficult it is for a person to fall asleep and remain in a sleeping state, and how many times they wake up during a single night. Poor sleep quality disrupts the cycle of transition between the different stages of sleep. Subjective sleep quality in turn refers to a sense of being rested and regenerated after awaking from sleep. A study by A. Harvey et al. (2002) found that insomniacs were more demanding in their evaluations of sleep quality than individuals who had no sleep problems. Homeostatic sleep propensity (the need for sleep as a function of the amount of time elapsed since the last adequate sleep episode) must be balanced against the circadian element for satisfactory sleep. Along with corresponding messages from the circadian clock, this tells the body it needs to sleep. A person who regularly awakens at an early hour will generally not be able to sleep much later than his or her normal waking time, even if moderately sleep-deprived . The timing is correct when the following two circadian markers occur after the middle of the sleep episode and before awakening: maximum concentration of the hormone melatonin, and minimum core body temperature. Ideal duration ,Reference list is found on image page in Commons: Commons:File:Effects of sleep deprivation.svg#References indicating impairment of normal maintenance by sleep.]] Human sleep needs vary by age and amongst individuals; sleep is considered to be adequate when there is no daytime sleepiness or dysfunction. Moreover, self-reported sleep duration is only moderately correlated with actual sleep time as measured by actigraphy, and those affected with sleep state misperception may typically report having slept only four hours despite having slept a full eight hours.Insomnia Causes . Healthcommunities.com. Original Publication: 1 December 2000, Updated: 1 December 2007. Researchers have found that sleeping 6–7 hours each night correlates with longevity and cardiac health in humans, though many underlying factors may be involved in the causality behind this relationship. ; cf. Sleep difficulties are furthermore associated with psychiatric disorders such as depression, alcoholism, and bipolar disorder. Up to 90 percent of adults with depression are found to have sleep difficulties. Dysregulation detected by EEG includes disturbances in sleep continuity, decreased delta sleep and altered REM patterns with regard to latency, distribution across the night and density of eye movements. Children sleeping, 3rd century BC–early 1st century AD]] By the time infants reach the age of two, their brain size has reached 90 percent of an adult-sized brain; a majority of this brain growth has occurred during the period of life with the highest rate of sleep. The hours that children spend asleep influence their ability to perform on cognitive tasks. Children who sleep through the night and have few night waking episodes have higher cognitive attainments and easier temperaments than other children. Sleep also influences language development. To test this, researchers taught infants a faux language and observed their recollection of the rules for that language. Infants who slept within four hours of learning the language could remember the language rules better, while infants who stayed awake longer did not recall those rules as well. There is also a relationship between infants' vocabulary and sleeping: infants who sleep longer at night at 12 months have better vocabularies at 26 months. Recommendations Children need many hours of sleep per day in order to develop and function properly: up to 18 hours for newborn babies, with a declining rate as a child ages. Early in 2015, after a two-year study, the National Sleep Foundation in the US announced newly revised recommendations as shown in the table below. Functions Restoration The human organism physically restores itself during sleep, healing itself and removing metabolic wastes which build up during periods of activity. This restoration takes place mostly during slow-wave sleep, during which body temperature, heart rate, and brain oxygen consumption decrease. The brain, especially, requires sleep for restoration, whereas in the rest of the body these processes can take place during quiescent waking. In both cases, the reduced rate of metabolism enables countervailing restorative processes.Raymond Cespuglio, Damien Colas, & Sabine Gautier-Sauvigné, "Energy Processes Underlying the Sleep Wake Cycle"; Chapter 1 in Parmeggiani & Velluti (2005). While awake, metabolism generates reactive oxygen species, which are damaging to cells. During sleep, metabolic rates decrease and reactive oxygen species generation is reduced allowing restorative processes to take over. The sleeping brain has been shown to remove metabolic waste products at a faster rate than during an awake state. It is further theorized that sleep helps facilitate the synthesis of molecules that help repair and protect the brain from these harmful elements generated during waking. Anabolic hormones such as growth hormones are secreted preferentially during sleep. The concentration of the sugar compound glycogen in the brain increases during sleep, and is depleted through metabolism during wakefulness. Studies suggest that sleep deprivation may impair the body's ability to heal wounds. It has been shown that sleep deprivation affects the immune system. It is now possible to state that "sleep loss impairs immune function and immune challenge alters sleep," and it has been suggested that sleep increases white blood cell counts. A 2014 study found that depriving mice of sleep increased cancer growth and dampened the immune system's ability to control cancers.Peres, Judy (14 March 2012) A good reason to get your zzz's Chicago Tribune Health, retrieved 26 March 2014 The effect of sleep duration on somatic growth is not completely known. One study recorded growth, height, and weight, as correlated to parent-reported time in bed in 305 children over a period of nine years (age 1–10). It was found that "the variation of sleep duration among children does not seem to have an effect on growth." It is well established that slow-wave sleep affects growth hormone levels in adult men. During eight hours' sleep, Van Cauter, Leproult, and Plat found that the men with a high percentage of slow-wave sleep (SWS) (average 24%) also had high growth hormone secretion, while subjects with a low percentage of SWS (average 9%) had low growth hormone secretion. Memory processing Sleep enhances memory, with procedural memory benefiting from late, REM-rich sleep, and explicit memory benefiting from early, slow wave-rich sleep. Dreaming During sleep, especially REM sleep, people tend to have dreams: elusive first-person experiences which seem realistic while in progress, despite their frequently bizarre qualities. Dreams can seamlessly incorporate elements within a person's mind that would not normally go together. They can include apparent sensations of all types, especially vision and movement.J. Alan Hobson, Edward F. Pace-Scott, & Robert Stickgold (2000), "Dreaming and the brain: Toward a cognitive neuroscience of conscious states", Behavioral and Brain Sciences 23. People have proposed many hypotheses about the functions of dreaming. Sigmund Freud postulated that dreams are the symbolic expression of frustrated desires that have been relegated to the unconscious mind, and he used dream interpretation in the form of psychoanalysis in attempting to uncover these desires.See Freud: The Interpretation of Dreams. Counterintuitively, penile erections during sleep are not more frequent during sexual dreams than during other dreams. The parasympathetic nervous system experiences increased activity during REM sleep which may cause erection of the penis or clitoris. In males, 80% to 95% of REM sleep is normally accompanied by partial to full penile erection, while only about 12% of men's dreams contain sexual content. John Allan Hobson and Robert McCarley propose that dreams are caused by the random firing of neurons in the cerebral cortex during the REM period. Neatly, this theory helps explain the irrationality of the mind during REM periods, as, according to this theory, the forebrain then creates a story in an attempt to reconcile and make sense of the nonsensical sensory information presented to it. This would explain the odd nature of many dreams. Using antidepressants, acetaminophen, ibuprofen, or alcoholic beverages is thought to potentially suppress dreams, whereas melatonin may have the ability to encourage them. Disorders Insomnia Insomnia is a general term for difficulty falling asleep and/or staying asleep. Insomnia is the most common sleep problem, with many adults reporting occasional insomnia, and 10–15% reporting a chronic condition.Brown, pp. 1146–1147. Insomnia can have many different causes, including psychological stress, a poor sleep environment, an inconsistent sleep schedule, or excessive mental or physical stimulation in the hours before bedtime. Insomnia is often treated through behavioral changes like keeping a regular sleep schedule, avoiding stimulating or stressful activities before bedtime, and cutting down on stimulants such as caffeine. The sleep environment may be improved by installing heavy drapes to shut out all sunlight, and keeping computers, televisions and work materials out of the sleeping area. A 2010 review of published scientific research suggested that exercise generally improves sleep for most people, and helps sleep disorders such as insomnia. The optimum time to exercise may be 4 to 8 hours before bedtime, though exercise at any time of day is beneficial, with the exception of heavy exercise taken shortly before bedtime, which may disturb sleep. However, there is insufficient evidence to draw detailed conclusions about the relationship between exercise and sleep. Sleeping medications such as Ambien and Lunesta are an increasingly popular treatment for insomnia. Although these nonbenzodiazepine medications are generally believed to be better and safer than earlier generations of sedatives, they have still generated some controversy and discussion regarding side-effects. White noise appears to be a promising treatment for insomnia. Obstructive sleep apnea Obstructive sleep apnea is a condition in which major pauses in breathing occur during sleep, disrupting the normal progression of sleep and often causing other more severe health problems. Apneas occur when the muscles around the patient's airway relax during sleep, causing the airway to collapse and block the intake of oxygen. Obstructive sleep apnea is more common than central sleep apnea. As oxygen levels in the blood drop, the patient then comes out of deep sleep in order to resume breathing. When several of these episodes occur per hour, sleep apnea rises to a level of seriousness that may require treatment. Diagnosing sleep apnea usually requires a professional sleep study performed in a sleep clinic, because the episodes of wakefulness caused by the disorder are extremely brief and patients usually do not remember experiencing them. Instead, many patients simply feel tired after getting several hours of sleep and have no idea why. Major risk factors for sleep apnea include chronic fatigue, old age, obesity and snoring. Other disorders Sleep disorders include narcolepsy, periodic limb movement disorder (PLMD), restless leg syndrome (RLS), upper airway resistance syndrome (UARS), and the circadian rhythm sleep disorders. Fatal familial insomnia, or FFI, an extremely rare genetic disease with no known treatment or cure, is characterized by increasing insomnia as one of its symptoms; ultimately sufferers of the disease stop sleeping entirely, before dying of the disease.Max, D. T. The Secrets of Sleep National Geographic Magazine, May 2010. Somnambulism, known as sleep walking, is also a common sleeping disorder, especially among children. In somnambulism the individual gets up from his/her sleep and wanders around while still sleeping.Dugdale, David, C. (22 May 2011). Sleepwalking . US National institutes of health. Older people may be more easily awakened by disturbances in the environmentHow Aging Changes Sleep Patterns by Allison Aubrey. Morning Edition, 3 August 2009. and may to some degree lose the ability to consolidate sleep. Drugs and diet Drugs which induce sleep, known as hypnotics, include benzodiazepines, although these interfere with REM; Nonbenzodiazepine hypnotics such as eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien); Antihistamines, such as diphenhydramine (Benadryl) and doxylamine; Alcohol (ethanol), despite its rebound effect later in the night and interference with REM;Alcohol and Sleep . Alcoholism.about.com (10 January 2011). Retrieved on 1 December 2011. barbiturates, which have the same problem; melatonin, a component of the circadian clock, and released naturally at night by the pineal gland;Fred W. Turek & Charles A. Czeisler (1999). "Role of Melatonin in the Regulation of Sleep", in Turek & Zee (eds.), Regulation of Sleep and Circadian Rhythms, pp. 181–195. and cannabis, which may also interfere with REM.Marijuana, Sleep and Dreams. psychologytoday.com. Retrieved on 10 February 2012. Stimulants, which inhibit sleep, include caffeine, an adenosine antagonist; amphetamine, MDMA, empathogen-entactogens, and related drugs; cocaine, which can alter the circadian rhythm, Primary hypersomnia: Diagnostic Features. mindsite.com and methylphenidate, which acts similarly; and other analeptic drugs like modafinil and armodafinil with poorly understood mechanisms. Dietary and nutritional choices may affect sleep duration and quality. One 2016 review indicated that a high carbohydrate diet promoted shorter onset to sleep and longer duration sleep than a high fat diet. A 2012 investigation indicated that mixed micronutrients and macronutrients are needed to promote quality sleep. A varied diet containing fresh fruits and vegetables, low saturated fat, and whole grains may be optimal for individuals seeking to improve sleep quality. High-quality clinical trials on long-term dietary practices are needed to better define the influence of diet on sleep quality. In culture Anthropology '' by Pieter Bruegel the Elder, 1567.]] Research suggests that sleep patterns vary significantly across cultures. Slumber's Unexplored Landscape . Science News Online (25 September 1999). Retrieved on 1 December 2011. The most striking differences are observed between societies that have plentiful sources of artificial light and ones that do not. The primary difference appears to be that pre-light cultures have more broken-up sleep patterns. For example, people without artificial light might go to sleep far sooner after the sun sets, but then wake up several times throughout the night, punctuating their sleep with periods of wakefulness, perhaps lasting several hours. The boundaries between sleeping and waking are blurred in these societies. Some observers believe that nighttime sleep in these societies is most often split into two main periods, the first characterized primarily by deep sleep and the second by REM sleep. Some societies display a fragmented sleep pattern in which people sleep at all times of the day and night for shorter periods. In many nomadic or hunter-gatherer societies, people will sleep on and off throughout the day or night depending on what is happening. Plentiful artificial light has been available in the industrialized West since at least the mid-19th century, and sleep patterns have changed significantly everywhere that lighting has been introduced. In general, people sleep in a more concentrated burst through the night, going to sleep much later, although this is not always the case. Historian A. Roger Ekirch thinks that the traditional pattern of "segmented sleep," as it is called, began to disappear among the urban upper class in Europe in the late 17th century and the change spread over the next 200 years; by the 1920s "the idea of a first and second sleep had receded entirely from our social consciousness." Ekirch attributes the change to increases in "street lighting, domestic lighting and a surge in coffee houses," which slowly made nighttime a legitimate time for activity, decreasing the time available for rest. Today in most societies people sleep during the night, but in very hot climates they may sleep during the day.Huntington, Ellsworth (1915) [https://archive.org/details/civilizationand01huntgoog Civilization and Climate] . Yale University Press. p. 126 During Ramadan, many Muslims sleep during the day rather than at night. In some societies, people sleep with at least one other person (sometimes many) or with animals. In other cultures, people rarely sleep with anyone except for an intimate partner. In almost all societies, sleeping partners are strongly regulated by social standards. For example, a person might only sleep with the immediate family, the extended family, a spouse or romantic partner, children, children of a certain age, children of specific gender, peers of a certain gender, friends, peers of equal social rank, or with no one at all. Sleep may be an actively social time, depending on the sleep groupings, with no constraints on noise or activity. People sleep in a variety of locations. Some sleep directly on the ground; others on a skin or blanket; others sleep on platforms or beds. Some sleep with blankets, some with pillows, some with simple headrests, some with no head support. These choices are shaped by a variety of factors, such as climate, protection from predators, housing type, technology, personal preference, and the incidence of pests. In mythology and literature from the Menologion of Basil II (985 AD), showing the Seven Sleepers of Ephesus sleeping in their cave]] Sleep has been seen in culture as similar to death since antiquity; in Greek mythology, Hypnos (the god of sleep) and Thanatos (the god of death) were both said to be the children of Nyx (the goddess of night). John Donne, Samuel Taylor Coleridge, Percy Bysshe Shelley, and other poets have all written poems about the relationship between sleep and death. Shelley describes them as "both so passing, strange and wonderful!" Many people consider dying in one's sleep the most peaceful way to die. Phrases such as "big sleep" and "rest in peace" are often used in reference to death, possibly in effort to lessen its finality. Sleep has sometimes been seen as a visionary experience. In medieval Irish tradition, in order to become a filí, a poet was required to undergo a ritual called the imbas forosnai, in which he would enter a mantic, trance-like sleep. Many cultural stories have been told about people falling asleep for extended periods of time. The earliest of these stories is the ancient Greek legend of Epimenides of Knossos. According to the biographer Diogenes Laërtius, Epimenides was a shepherd on the Greek island of Crete. One day, one of his sheep went missing and he went out to look for it, but became tired and fell asleep in a cave under Mount Ida. When he awoke, he continued searching for the sheep, but could not find it, so he returned to his old farm, only to discover that it was now under new ownership. He went to his hometown, but discovered that nobody there knew him. Finally, he met his younger brother, who was now an old man, and learned that he had been asleep in the cave for fifty-seven years. A far more famous instance of a "long sleep" today is the Christian legend of the Seven Sleepers of Ephesus, in which seven Christians flee into a cave during pagan times in order to escape persecution, but fall asleep and wake up 360 years later to discover, to their astonishment, that the Roman Empire is now predominantly Christian. The American author Washington Irving's short story "Rip Van Winkle", first published in 1819 in his collection of short stories The Sketch Book of Geoffrey Crayon, Gent., is about a man in colonial America named Rip Van Winkle who falls asleep on one of the Catskill Mountains and wakes up twenty years later after the American Revolution. The story is now considered one of the greatest classics of American literature. In art Writing about the thematical representations of sleep in art, physician and sleep researcher Meir Kryger noted: "Artists have intense fascination with mythology, dreams, religious themes, the parallel between sleep and death, reward, abandonment of conscious control, healing, a depiction of innocence and serenity, and the erotic." File:Carel Fabritius - De poort bewaker (1654).jpg|''The Sentry'' (1654) by Carel Fabritius File:Museo del Prado - Goya - Caprichos - No. 43 - El sueño de la razon produce monstruos.jpg|''The Sleep of Reason Produces Monsters'' (1799) by Francisco Goya File:J%C3%A9r%C3%B4me-Martin_Langlois_-_Diana_and_Endymion_-_WGA12461.jpg|''Diana and Endymion'' ( 1822) by Jérôme-Martin Langlois File:Honoré Daumier - The Second Class Carriage - Walters 371224.jpg|''The Second Class Carriage'' (1864) by Honoré Daumier File:Waterhouse-sleep and his half-brother death-1874.jpg|''Sleep and his Half-brother Death'' (1874) by John William Waterhouse File:William-Adolphe Bouguereau (1825-1905) - Lullaby (1875).jpg|''Lullaby'' (1875) by William-Adolphe Bouguereau File:Илья Е. Репин - Отдых. Портрет В.А.Репинa (1882).jpg|''Taking a Rest'' (1882) by Ilya Repin File:George Hare - Victory of Faith.jpg|''Victory of Faith'' (1889) by Saint George Hare File:Auf dem Ofen 1895.jpg|''Zwei schlafende Mädchen auf der Ofenbank'' (1895) Albert Anker File:Flaming June, by Frederic Lord Leighton (1830-1896).jpg|''Flaming June'' ( 1895) by Frederic Lord Leighton File:Noon, rest from work - Van Gogh.jpeg|''Noon – Rest from Work'' (1890) by Vincent van Gogh (after Millet) File:Paul Klimsch Schlafender Jaguar.jpg|''Sleeping Jaguar'', by Paul Klimsch File:Albert Anker - Schlafendes Mädchen auf einer Holzbank.jpg|''Sleeping Girl on a Wooden Bench'' by Albert Anker File:Chrapek, the Sleepy one... (3734650615).jpg|''Chrapek'' (Snorer), Wrocław's dwarfs See also * Microsleep * Morvan's syndrome * Oleamide * Power nap * Rheum * Sleep epidemiology * Sleep in space * Sleep-learning * Sleep medicine * Sleep paralysis * Somnology * Somnophilia * Sudden infant death syndrome * Sudden unexpected death syndrome Positions, practices, and rituals * Sleeping positions * Co-sleeping * Hypnosis * Meditation * Neutral spine * Sleep hygiene * Yoga-nidra * World Sleep Day * Unconsciousness References Sources * * Parmeggiani, Pier Luigi, & Ricardo A. Velluti, eds. (2005). The Physiologic Nature of Sleep. London: Imperial College Press. . * Parmeggiani, Pier Luigi (2011). Systemic Homeostasis and Poikilostasis in Sleep: Is REM Sleep a Physiological Paradox? London: Imperial College Press. * Turek, Fred W. & Phyllis C. Zee, eds. (1999). Regulation of Sleep and Circadian Rhythms. New York: Marcel Dekker, Inc. External links * Rethinking Sleep, David K. Randall, New York Times, September 2012 * How to Sleep, James Hamblin, The Atlantic, January 2017 Category:Sleep Category:Psychological states Category:Unsolved problems in neuroscience